Editor-I read with interest the paper by Brindley and colleagues. The authors should be congratulated for their attempt to promote evidence-based instruction, but I do not agree that their study justifies the conclusion that, overall, 'win with the chin' was a superior teaching analogy and could replace the 'sniffing position' analogy. The instruction 'please position the manikin in the best position in order to sniff the morning air, or to sniff for smoke' (the so-called sniffing position) is not the traditional sniffing position analogy. It is a very different instruction to 'please position the manikin in the best position in order to sniff the morning air'. I am sure that many people would consider the position required to sniff for smoke to be very different from that associated with sniffing the morning air. Furthermore, their study used only written instructions and this is highly artificial. There is no requirement for a written instruction alone that will result in novices correctly positioning a patient for intubation. The requirement is for an easily recalled phrase that will remind the trainee of the optimal position for intubation after they have had the position explained and demonstrated to them. The phrase 'sniffing the morning air' has fulfilled this purpose for some time for those whose first language is English. I wonder what phrase is used in other languages? The authors use a manikin for their study and point out some of its limitations; these can easily be overcome by using a human volunteer. There is no need to use a manikin to teach basic airway positioning, a human being is far more life like and I wonder why they chose to use a manikin for their study.
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